不同红细胞分布宽度在射血分数保留的心力衰竭患者中的差异

A comparative study of different red blood cell distribution width in patients with heart failure with preserved ejection fraction

目的探讨不同程度红细胞分布宽度(RDW)在射血分数保留的心力衰竭(HFPEF)患者中的临床差异性。方法选择69例心力衰竭患者,根据RDW不同分为低RDW组(RDW<13.6%)28例与高RDW组(RDW>13.6%)41例,比较2组间的一般资料、血生化、心力衰竭标记物及超声心动图的差异。结果高RDW组高血压患者明显增多(P<0.05);2组患者他汀类药物及阿司匹林使用情况,肌酐、TC、LDL、NT-pro BNP水平及E/Em(mean)、PCWP比较均有显著性差异(P均<0.05)。直线相关分析显示RDW水平与肌酐(r=0.364,P<0.05)、TC(r=0.414,P<0.05)、NT-pro BNP(r=0.638,P<0.01)、平均舒张早期心室充盈峰速与二尖瓣环舒张早期峰速之比(E/Em)(r=0.356,P<0.05)、肺毛细血管楔压(r=0.487,P<0.05)呈正相关,而与LDL呈负相关(r=-0.523,P<0.05)。结论不同RDW在HFPEF患者中存在诸多临床指标的差异,这可能与患者体内左室充盈压、神经内分泌激素、氧化应激的改变有关。

Objective It is to investigate the clinical differences of different red blood cell distribution width （RDW） in patients with heart failure with preserved ejection fraction （ HFPEF）. Methods 69 patients with HFPEF were randomly divided into the low RDW group （RDW 〈 13.6% ,n = 28） and high the enalapril group（ RDW 〉 13.6% ,n = 41 ）. The differences in several indexes like the general clinical data, blood biochemistry, heart failure markers, echocardiography between the two groups were compared. Results The hypertension patients were increased in high RDW group ; Statin and aspirin could affect RDW（P 〈 0.05）; The concentration of serum TC, LDL, NT- proBNP were changed obviously in high RDW group （P 〈 0. 05 ） ; higher E/Em （mean） , PCWP were occurred in high RDW group（ P 〈 0. 05 ） ; Linear correlation analysis showed that the RDW levels were positively related with the following parameters ： creatinine （ r = 0. 364, P 〈 0.05）, TC （ r = 0. 414, P 〈 0.05）, NT-proBNP（r=0.638, P〈0.01）, E/Era （r=0.356, P〈0.05）, PCWP （r=0.487, P〈0.05）, but was neg- atively correlated with LDL （r = - 0. 523, P 〈 0. 05）. Conclusion There are many differences of clinical indexes in HFPEF patients with different RDW levels, which may be related to left ventricular filling pressure, neuroendocrine hormone, oxida- tive stress.